Volvulus

A 2-day-old neonate presents with bilious vomiting and irritability. On physical examination, she has abdominal distention and high-pitched bowel sounds. Barium enema radiograph reveals a dilated sigmoid colon with a column of barium resembling a "coffee bean".

Introduction

Malrotation of gut from errors during development increases risk of volvulus

Volvulus (typically, midgut)

abnormal rotation of bowel

strangulation of SMA

compromised blood flow to bowel

Epidemiology

most common in newborns

males > females

Associated conditions

situs inversus

cardiovascular defects

heterotaxy

gastroschisis/omphalocele

Presentation

Symptoms

neonates

bilious vomiting within first week of life

colicky pain

older patients

bilious or nonbilious vomiting

crampy abdominal pain

change in bowel pattern

nausea

Physical exam

abdominal distention

abdominal tenderness

Evaluation

abdominal radiography

may have air fluid levels

upper GI imaging with barium enema

“bird beak” appearance at site of rotation

failure of duodenum to cross midline = malrotation

Differential Diagnosis

Intussusception

Intestinal atresia

Gastroenteritis

Appendicitis

Meckel diverticulum

Treatment

Malrotation without volvulus

elective Ladd procedure

Malrotation with volvulus (symptomatic or acute abdomen)

emergent endoscopic decompression

surgical decompression

Prognosis, Prevention, and Complications

Prognosis

good with treatment

Complications

bowel necrosis

perforation

sepsis

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